Department of Neurosurgery, Klinikum Kassel, Moencheberg Str. 41-43, 34125, Kassel, Germany.
Kassel School of Medicine, University of Southampton, 12 University Rd, Southampton, SO17 1BJ, UK.
Acta Neurochir (Wien). 2020 Oct;162(10):2431-2439. doi: 10.1007/s00701-020-04475-7. Epub 2020 Jul 4.
Cerebrospinal fluid (CSF) shunting is a highly effective treatment for idiopathic normal pressure hydrocephalus (iNPH). However, secondary deterioration can occur at a later time. Thus, the current study aimed to evaluate the incidence rate and causes of secondary deterioration.
A retrospective analysis was conducted on all patients with iNPH who were treated with implantation of a CSF shunt since 1993. A meticulous shunt workup was recommended to all patients who presented to our department with secondary deterioration during their follow-up visits. Data about the proportion of patients with such deterioration and its causes, subsequent treatment, and clinical outcome were obtained.
A total of 169 patients were included, and the mean follow-up time was 69.2 months. In total, 119 (70.4%) patients presented with a total of 153 secondary deteriorations. In 9 cases (5.9%), the deterioration was caused by delayed subdural hematoma and in 27 (22.1%) cases, by shunt dysfunction. Invasive shunt testing was commonly required to validate shunt failure. Moreover, 19 of 27 patients experienced a satisfactory improvement after revision surgery. In total, 86 deteriorations were attributed to nonsurgical causes, and the valve pressure was decreased in 79 patients, with only 16.5% presenting with a satisfactory improvement after lowering of valve pressure.
Most patients with shunted iNPH presented with deterioration in the later course of the disease. Shunt dysfunction was considered a cause of secondary deterioration. Moreover, shunt revision surgery was a highly effective treatment, and patients with deterioration should undergo screening procedures for shunt dysfunction, including invasive shunt testing.
脑脊髓液（CSF）分流术是治疗特发性正常压力脑积水（iNPH）的一种非常有效的方法。然而，在后期可能会出现继发性恶化。因此，本研究旨在评估继发性恶化的发生率和原因。
对 1993 年以来接受 CSF 分流术治疗的所有 iNPH 患者进行回顾性分析。建议所有在随访过程中出现继发性恶化的患者进行细致的分流检查。获取有关出现这种恶化的患者比例及其原因、后续治疗和临床结果的数据。
共纳入 169 例患者，平均随访时间为 69.2 个月。共有 119 例（70.4%）患者出现 153 次继发性恶化。9 例（5.9%）恶化是由迟发性硬膜下血肿引起的，27 例（22.1%）是由分流管功能障碍引起的。通常需要进行有创性分流测试来验证分流失败。此外，27 例患者中有 19 例在修正手术后获得了满意的改善。总共 86 次恶化归因于非手术原因，79 例患者的阀门压力降低，只有 16.5%的患者在降低阀门压力后有满意的改善。
大多数接受分流术治疗的 iNPH 患者在疾病的后期会出现恶化。分流管功能障碍被认为是继发性恶化的原因。此外，分流修正手术是一种非常有效的治疗方法，出现恶化的患者应进行分流管功能障碍的筛查程序，包括有创性分流测试。
